Protocol Overview

Note: Some Protocols contain images. You may click the thumbnails to preview the full image. To print Protocols with full size images, please add those Protocols to your Toolkit and Generate a Report.

Medication Inventory #140301

Protocol Release Date

October 1, 2015

Protocol Name From Source

2000 Multi-Ethnic Study of Arthrosclerosis (MESA), Medications

Description of Protocol

Participants are asked to bring all their current medications with them at the time of their appointment. For prescription medications, the interviewer records the name of the medications, the strength, the number prescribed, and the actual amount taken during the last 2 weeks. For over-the-counter medications (including vitamins and supplements), the interviewer records the name, strength, and actual amount consumed in the previous 2 weeks.

Specific Instructions

Researchers should review the Multi-Ethnic Study of Atherosclerosis Medication (MESA) Methods section in the Diabetes Supplemental Information for specific directions on coding medications (see Diabetes Supplemental Information, MESA Manual of Operations). The U.S. Food and Drug Administration (FDA) maintains a searchable database of brand-name drugs, generic drugs, and therapeutic biological products, which is useful in classifying the medications.

Expert Review Panel note: The Expert Review Panel wants to alert investigators to the fact that the form requests information about medications taken over the previous 2 weeks, which may result in the form omitting a medication taken on a monthly basis. However, this medication will be captured in the prescribed medication section.

Protocol

Medication Reception

As you know, the XXX Study will be describing all medications its participants are using, both prescription and over-the-counter. These include pills, liquid medications, skin patches, eye drops, creams, salves, inhalers, and injections, as well as cold or allergy medications, vitamins, herbal remedies, and other supplements. The letter you received about this appointment included a plastic medications bag for all your current medications and asked you to bring them to the clinic. Have you brought this bag with you? Are these all the medications that you have taken in the past 2 weeks?

[ ]

Yes → May I see them? Continue with Section B

[ ]

No →Make arrangements to obtain

[ ]

Refused →Record reason for refusal in Comments Section

[ ]

Took No MEDICINES →Go to end of form

Prescription Medications

1. Copy the name of the medicine, the strength (include units), and the total number of doses prescribed per day/week/month. Include all pills, skin patches, eye drops, creams, salves, and injections.

Medication NamePrint the first 20 letters only-Please print clearly

Strength (mg, IU, etc.) Write the decimal as one of the digits

Number PrescribedCircle: Day, Week, Month

PRNMedicine?

On the average during the last 2 weeks, how many of these pills did you take a day/week/month?

1.

___D W M

Y N

___D W M

2.

___D W M

Y N

___D W M

3.

___D W M

Y N

___D W M

4.

___D W M

Y N

___D W M

5.

___D W M

Y N

___D W M

6.

___D W M

Y N

___D W M

7.

___D W M

Y N

___D W M

8.

___D W M

Y N

___D W M

9.

___D W M

Y N

___D W M

10.

___D W M

Y N

___D W M

11.

___D W M

Y N

___D W M

12.

___D W M

Y N

___D W M

13.

___D W M

Y N

___D W M

14.

___D W M

Y N

___D W M

15.

___D W M

Y N

___D W M

Number unable to transcribe: [ ][ ]

Over-the-Counter Medications

3. Copy the name of the medicine, the strength (include units), and the total number of doses prescribed per day/week/month. Include all pills, skin patches, eye drops, creams, salves, and injections.

Medication NamePrint the first 20 letters only-Please print clearly

Strength (mg, IU, etc.) Write the decimal as one of the digits

Number PrescribedCircle: Day, Week, Month

PRNMedicine?

On the average during the last 2 weeks, how many of these pills did you take a day/week/month?

The U.S. Food and Drug Administration (FDA) maintains a searchable database of brand-name drugs, generic drugs, and therapeutic biological products that can assist with classification and action of medications.

On the average during the last two weeks, how many of these pills did you take a day/week/month

4

N/A

PX140301_Average_Taken_DayWeek_Month_Prescription_Medication1

PX140301020501

Circle: Day, Week, Month

4

N/A

PX140301_Name_Of_Prescription_Medication2

PX140301030100

Print the first 20 letters only-Please print clearly.

4

N/A

PX140301_Strength_Prescription_Medication2

PX140301030200

Strength (mg, IU, etc.). Write the decimal one of the digits.

4

N/A

PX140301_Units_Prescription_Medication2

PX140301030201

Record the units of the strength of prescription medication

4

N/A

PX140301_Number_Prescribed_Prescription_Medication2

PX140301030300

Number Prescribed

4

N/A

PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication2

PX140301030301

Circle: Day, Week, Month

4

N/A

PX140301_PRN_Medicine_Prescription_Medication2

PX140301030400

PRN Medicine?

4

N/A

PX140301_Average_Number_Pills_Prescription_Medication2

PX140301030500

On the average during the last two weeks, how many of these pills did you take a day/week/month

4

N/A

PX140301_Average_Taken_DayWeek_Month_Prescription_Medication2

PX140301030501

Circle: Day, Week, Month

4

N/A

PX140301_Name_Of_Prescription_Medication3

PX140301040100

Print the first 20 letters only-Please print clearly.

4

N/A

PX140301_Strength_Prescription_Medication3

PX140301040200

Strength (mg, IU, etc.). Write the decimal one of the digits.

4

N/A

PX140301_Units_Prescription_Medication3

PX140301040201

Record the units of the strength of prescription medication

4

N/A

PX140301_Number_Prescribed_Prescription_Medication3

PX140301040300

Number Prescribed

4

N/A

PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication3

PX140301040301

Circle: Day, Week, Month

4

N/A

PX140301_PRN_Medicine_Prescription_Medication3

PX140301040400

PRN Medicine?

4

N/A

PX140301_Average_Number_Pills_Prescription_Medication3

PX140301040500

On the average during the last two weeks, how many of these pills did you take a day/week/month

4

N/A

PX140301_Average_Taken_DayWeek_Month_Prescription_Medication3

PX140301040501

Circle: Day, Week, Month

4

N/A

PX140301_Name_Of_Prescription_Medication4

PX140301050100

Print the first 20 letters only-Please print clearly.

4

N/A

PX140301_Strength_Prescription_Medication4

PX140301050200

Strength (mg, IU, etc.). Write the decimal one of the digits.

4

N/A

PX140301_Units_Prescription_Medication4

PX140301050201

Record the units of the strength of prescription medication

4

N/A

PX140301_Number_Prescribed_Prescription_Medication4

PX140301050300

Number Prescribed

4

N/A

PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication4

PX140301050301

Circle: Day, Week, Month

4

N/A

PX140301_PRN_Medicine_Prescription_Medication4

PX140301050400

PRN Medicine?

4

N/A

PX140301_Average_Number_Pills_Prescription_Medication4

PX140301050500

On the average during the last two weeks, how many of these pills did you take a day/week/month

4

N/A

PX140301_Average_Taken_DayWeek_Month_Prescription_Medication4

PX140301050501

Circle: Day, Week, Month

4

N/A

PX140301_Name_Of_Prescription_Medication5

PX140301060100

Print the first 20 letters only-Please print clearly.

4

N/A

PX140301_Strength_Prescription_Medication5

PX140301060200

Strength (mg, IU, etc.). Write the decimal one of the digits.

4

N/A

PX140301_Units_Prescription_Medication5

PX140301060201

Record the units of the strength of prescription medication

4

N/A

PX140301_Number_Prescribed_Prescription_Medication5

PX140301060300

Number Prescribed

4

N/A

PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication5

PX140301060301

Circle: Day, Week, Month

4

N/A

PX140301_PRN_Medicine_Prescription_Medication5

PX140301060400

PRN Medicine?

4

N/A

PX140301_Average_Number_Pills_Prescription_Medication5

PX140301060500

On the average during the last two weeks, how many of these pills did you take a day/week/month

4

N/A

PX140301_Average_Taken_DayWeek_Month_Prescription_Medication5

PX140301060501

Circle: Day, Week, Month

4

N/A

PX140301_Name_Of_Prescription_Medication6

PX140301070100

Print the first 20 letters only-Please print clearly.

4

N/A

PX140301_Strength_Prescription_Medication6

PX140301070200

Strength (mg, IU, etc.). Write the decimal one of the digits.

4

N/A

PX140301_Units_Prescription_Medication6

PX140301070201

Record the units of the strength of prescription medication

4

N/A

PX140301_Number_Prescribed_Prescription_Medication6

PX140301070300

Number Prescribed

4

N/A

PX140301_Number_Prescribed_DayWeekMonth_Prescription_Medication6

PX140301070301

Circle: Day, Week, Month

4

N/A

PX140301_PRN_Medicine_Prescription_Medication6

PX140301070400

PRN Medicine?

4

N/A

PX140301_Average_Number_Pills_Prescription_Medication6

PX140301070500

On the average during the last two weeks, how many of these pills did you take a day/week/month

4

N/A

PX140301_Average_Taken_DayWeek_Month_Prescription_Medication6

PX140301070501

Circle: Day, Week, Month

4

N/A

PX140301_Name_Of_Prescription_Medication7

PX140301080100

Print the first 20 letters only-Please print clearly.

4

N/A

PX140301_Strength_Prescription_Medication7

PX140301080200

Strength (mg, IU, etc.). Write the decimal one of the digits.

4

N/A

PX140301_Units_Prescription_Medication7

PX140301080201

Record the units of the strength of prescription medication

4

N/A

PX140301_Number_Prescribed_Prescription_Medication7

PX140301080300

Number Prescribed

4

N/A

Selection Rationale

The Diabetes Working Group preferred a comprehensive, interviewer-administered review of medication containers to simple questions about insulin and oral diabetes medications because respondents may be taking many medications for multiple conditions.

Source

U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung and Blood Institute. (2000). Multi-Ethnic Study of Arthrosclerosis (MESA). Medications.

Life Stage

Child, Adolescent, Adult, Senior

Language

English, Mandarin Chinese, Spanish

Participant

Although this protocol was originally developed for participants between 45-84 years old, the Diabetes Working Group notes that it can be administered to adults of all ages or to children by an adult proxy.

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided.

Equipment Needs

These questions can be administered in a computerized or non-computerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.